Political patience urged on meaningful use assessment

Officials from the U.S. Department of Health & Human Services (HHS) made it known at the College of Healthcare Information Management Executives (CHIME) Annual Fall Forum this week that Republicans have been premature to criticize the EHR incentive programs administered by the Centers for Medicare and Medicaid Services (CMS).

Four GOP senators sent a letter to HHS Secretary Kathleen Sebelius on Oct. 17 questioning whether government-subsidized EHRs sometimes actually promote higher utilization of diagnostic testing and whether wider EHR adoption so far has increased Medicare billing.

Sens. Tom Coburn, MD, (R-Okla.), Richard Burr (R-N.C.), Pat Roberts (R-Kan.) and John Thune (R-S.D.) also asked for a meeting with CMS and Office of the National Coordinator for Health Information Technology (ONC) staff about the recently finalized Stage 2 meaningful use rules that set the requirements for EHR incentive payments.

The letter from the senators is less critical than one that Republican House members wrote two weeks earlier asking HHS to delay Stage 2 bonus payments for meaningful use starting in fiscal year 2015 and penalties for noncompliance set to start in 2015 until federal officials were able to better define interoperability standards.

Reps. Dave Camp (R-Mich.), Fred Upton (R-Mich.), Wally Herger (R-Calif.) and Joe Pitts (R-Pa.) contend in their letter that the Stage 2 rules are too weak to achieve the stated goals of creating a safer, more efficient healthcare system.

But at the CHIME CIO Forum, national health IT coordinator Farzad Mostashari, MD, appeared to shrug off the demands. Mostashari, a direct appointment by President Obama, called the response from CHIME "on the money." In a letter to each of the four House members last week, CHIME urged patience because Stage 2 does not even start until 2014.

Later at the CHIME conference, a nonpolitical representative of the CMS questioned whether the GOP realistically could shut down meaningful use in a budget-cutting move even if presidential candidate Mitt Romney were to win the election Nov. 6. Travis Broome, team lead for health IT policy and oversight at CMS – and an attorney – said suspending the meaningful use incentive program would require at least a regulatory revision and perhaps an act of Congress.

The regulatory process takes months or even years, and legislation reversing meaningful use seems unlikely unless Romney wins the presidency and the GOP both retains the House and wrests control of the Senate from Democrats in the voting.

Even so, the HITECH portion of the 2009 American Recovery and Reinvestment Act, which authorized the net $27 billion program, had broad, bipartisan support even if the full ARRA stimulus law did not.

CMS said last week that it had paid out $7.7 billion in Medicare and Medicaid incentive payments through September. Meanwhile, Mostashari said a national patient identifier is not the answer to the problem of matching patients to records from disparate databases, a major barrier to true EHR interoperability. When asked by a CHIME member about the ID issue, Mostashari responded with a question of his own: "Have our patient-matching problems gone away for all our elderly patients on Medicare? They all have a number."

The national coordinator said the quality and completeness of attributes in each database is more important than a national ID. "Let's do what we can do today," he advised.

The 1996 HIPAA law called on HHS to create a national patient ID, but Congress in 1999 voted not to fund the effort, citing privacy concerns, even though the federal government was running a budget surplus then. There has since been little desire in Washington to revisit the idea.